Like poverty, hunger and undernutrition among Ethiopians have decreased in recent decades but remain problematically high. Ethiopia’s 2000 Global Hunger Index (GHI) score was 55.9 - considered extremely alarming - whereas its 2018 GHI score is 29.1, which is at the upper end of the serious category (see About section for a guide to interpreting GHI scores). Each of the GHI indicators has also declined since 2000 (Figure 4.4). Yet serious threats remain.
An El Niño–induced drought worsened the food security situation in Ethiopia in 2016–2017 (FAO GIEWS 2017b). Furthermore, a flare-up of conflict in the Oromia and Somali regions in 2017 has led to the displacement of nearly 1 million people, threatening their agricultural activities, livelihoods, and food security (FEWS NET 2018a). Most Ethiopians consume a poor-quality diet that lacks a diverse range of foods; provides inadequate amounts of key nutrients including protein, vitamin A, and zinc as well as micronutrient-rich foods such as fruits and vegetables; and exposes consumers to food-borne pathogens (Gebru, Remans, and Brouwer 2018).
Of particular concern is the nutrition situation of children, given that poor nutrition during gestation and in the first two years of life has lifelong consequences. At 38.4 percent, Ethiopia’s child stunting level for children under five is considered “high” verging on “very high,” and at 9.9 percent its child wasting level for this age group is considered “poor” verging on “serious” according to World Health Organization guidelines (WHO 2010). These rates vary from region to region within Ethiopia, and in some cases the regional rates are substantially higher than the national averages (Table 4.2).
Poor feeding practices for infants and children seem to be a major factor behind these troubling numbers. Sixty-seven percent of children under the age of 24 months receive age-appropriate breastfeeding, but just 7.3 percent of children aged 6–23 months are fed the minimum acceptable diet. Even in Addis Ababa, which has the country’s largest share of children in this age group consuming the minimum acceptable diet, the rate is still low at just 27.1 percent (CSA and ICF 2016). Many other recent studies have documented the inadequacy of infant and young child feeding practices in various parts of Ethiopia, including Abiy Addi town, Tigray region (Mekbib et al. 2014), and Sidama Zone, Southern Nations, Nationalities, and Peoples’ Regional State (SNNP) (Tessema, Belachew, and Ersino 2013; Gibson et al. 2009). In many of these studies, the authors conclude that inadequate infant and young child feeding practices are a primary cause of child stunting. Even in an area with surplus food production (West Gojjam Zone, Amhara region), child stunting was found to be high in past research, and inappropriate feeding practices were the principal risk factor for nutritional deprivation among children under the age of five (Teshome et al. 2009).
The overall health of children also plays a role in their nutrition. Studies have shown that diarrheal disease is associated with child stunting, wasting, and underweight (Asfaw et al. 2015). In Haramaya woreda, Oromia region, diarrhea is associated with underweight, and fever is associated with wasting (Yisak, Gobena, and Mesfin 2015). The nutritional status of women is also important to consider, both for the sake of women themselves and for their children. Women with low levels of empowerment and decision-making power are about 50 percent more likely to experience undernutrition than other women (Tebekaw 2011). Approximately one-quarter of women of childbearing age in Ethiopia have a low body mass index (BMI), which puts their children’s nutritional status at risk (Negash et al. 2015; Tigga and Sen 2016). Early childbearing is common, with 27.7 percent of women giving birth before the age of 19, which places strain on the nutritional status of women and infants (USAID 2018a). In Debub Misraqawi Zone, Tigray region, breastfeeding women had inadequate dietary intake and poor anthropometric measures—factors that have negative implications for the nutrition of their children (Haileslassie, Mulugeta, and Girma 2013).
Livestock ownership—an important part of many Ethiopian households’ livelihoods—can contribute to children’s nutrition, but the link is not always straightforward. Cow ownership raises children’s milk consumption and height-for-age and reduces child stunting, particularly in areas where markets for milk are limited and home consumption is more important (data from Amhara, Oromiya, SNNP, and Tigray regions in Hoddinott, Headey, and Dereje 2015). Qualitative research in the pastoralist Sitti (formerly Shinile) and Liben Zones of Somali region revealed that animal milk plays a large role in the diets of young children, but that milk supply is vulnerable during the dry season and droughts (Sadler and Catley 2009). In Amhara, Oromia, Somali, SNNP, and Tigray regions, a household’s poultry ownership is positively associated with children’s height-for-age, but keeping poultry inside the home overnight is negatively associated with children’s height-for-age, suggesting a trade-off between improved diet and increased exposure to pathogens that can negatively affect nutritional status (Headey and Hirvonen 2016).
Finally, several studies show an association between market access, roads, and nutrition. All else being equal, children whose households are located closer to food markets in East Tigray Zone, Tigray region, have greater weight-for-age and weight-for-height, although proximity to markets is not sufficient to offset poor nutrition in the lean season (Abay and Hirvonen 2016). In Alefa woreda, Amhara region, remote communities have poorer diets than communities that are less remote (Stifel and Minten 2017). Mothers’ nutritional knowledge is positively associated with children’s dietary diversity in Alefa woreda, Amhara region, but only in areas with good access to markets (Hirvonen et al. 2017). Furthermore, children in households that produce a more diverse range of agricultural products tend to have more diverse diets, particularly in areas where there is poor market integration (Hirvonen and Hoddinott 2014).